Diagnosis

Your doctor can usually diagnose hot flashes based on a description of your symptoms. Your doctor might suggest blood tests to check whether you're in menopausal transition.

Treatment

The most effective way to relieve the discomfort of hot flashes is to take estrogen, but taking this hormone carries risks. If estrogen is appropriate for you and you start it within 10 years of your last menstrual period or before age 60, the benefits can be greater than the risks.

Medications such as antidepressants and anti-seizure drugs also might help reduce hot flashes, although they're less effective than hormones.

Discuss the pros and cons of various treatments with your doctor. If hot flashes don't interfere with your life, you probably don't need treatment. Hot flashes subside gradually for most women, even without treatment, but it can take several years for them to stop.

Hormone therapy

Estrogen is the primary hormone used to reduce hot flashes. Women who have had a hysterectomy can take estrogen alone. But if you still have a uterus, you should take progesterone with estrogen to protect against cancer of the lining of the uterus (endometrial cancer).

With either regimen, the therapy needs to be tailored to your needs. Guidelines suggest using the smallest effective dose for symptom control. How long you use the treatment depends on the balance of your risks and benefits from hormone therapy. The goal is to optimize your quality of life.

A combination drug of bazedoxifene with conjugated estrogens (Duavee) has been approved for treating menopausal symptoms. This drug might not increase your risk of uterine cancer and might protect your bones.

Estrogen therapy isn't a good option if you've had a blood clot or breast cancer.

Antidepressants

A low-dose form of paroxetine (Brisdelle) is the only nonhormone treatment for hot flashes approved by the Food and Drug Administration. Other antidepressants that have been used to treat hot flashes include:

  • Venlafaxine (Effexor XR, Pristiq)
  • Paroxetine (Paxil, Pexeva)
  • Fluoxetine (Prozac, Sarafem, others)

These medications aren't as effective as hormone therapy for severe hot flashes, but they can be helpful to women who can't use hormones. Possible side effects include nausea, dizziness, weight gain, dry mouth or sexual dysfunction.

Other prescription medications

Other medications that might offer relief for some women include:

  • Gabapentin (Neurontin, Gralise, others). Gabapentin is an anti-seizure medication that's moderately effective in reducing hot flashes. Side effects can include drowsiness, dizziness and headaches.
  • Clonidine (Catapres, Kapvay, others). Clonidine, a pill or patch typically used to treat high blood pressure, might provide some relief from hot flashes. Side effects include dizziness, drowsiness, dry mouth and constipation.

Nerve block procedure

A procedure known as stellate ganglian block has shown promise for treating moderate to severe hot flashes, but more research is needed. It involves injecting an anesthetic into a nerve cluster in the neck. The treatment has been used for pain management. Side effects include pain and bruising at the injection site.

Lifestyle and home remedies

If your hot flashes are mild, try managing them with these lifestyle changes:

  • Keep cool. Slight increases in your body's core temperature can trigger hot flashes. Dress in layers so that you can remove clothing when you feel warm.

    Open windows or use a fan or air conditioner. Lower the room temperature, if you can. If you feel a hot flash coming on, sip a cold drink.

  • Watch what you eat and drink. Hot and spicy foods, caffeinated beverages, and alcohol can trigger hot flashes. Learn to recognize your triggers and avoid them.
  • Relax. Some women find relief from mild hot flashes through meditation; slow, deep breathing; or other stress-reducing techniques. Even if these approaches don't quell your hot flashes, they might provide other benefits, such as easing sleep disturbances that tend to occur with menopause.
  • Don't smoke. Smoking is linked to increased hot flashes. By not smoking, you might reduce hot flashes, as well as your risk of many serious health conditions, such as heart disease, stroke and cancer.
  • Lose weight. If you're overweight or obese, losing weight might help ease your hot flashes.

Alternative medicine

Many women have turned to alternative medicine, including mind and body techniques and dietary supplements to help curb hot flashes. There is a shortage of well-designed studies on complementary health practices for hot flashes, but research is progressing.

Mind and body approaches

A growing body of evidence suggests that certain techniques can help ease hot flashes, including:

  • Mindfulness meditation. This type of meditation has you focus on what's happening from moment to moment. Although not shown to relieve hot flashes, it might reduce how much they bother you.
  • Acupuncture. Some studies indicate that acupuncture might reduce the frequency and severity of hot flashes, but results are conflicting, with many studies showing improvements in both active and control groups, but no difference between the two groups.
  • Hypnosis. Some research indicates that hypnosis might help relieve hot flashes.
  • Cognitive behavioral therapy. Some evidence indicates that this type of talk therapy (psychotherapy) might help you cope better with hot flashes.

Dietary supplements

People often assume that "natural" products cause no harm. However, all supplements may have potentially harmful side effects, and supplements can also interact with medications you're taking for other medical conditions. Always review what you're taking with your doctor.

Dietary supplements commonly used for menopause symptoms include:

  • Plant estrogens. Asian women, who consume soy regularly, are less likely to report hot flashes and other menopausal symptoms than are women in other parts of the world. One reason might be related to the estrogen-like compounds in soy.

    However, studies have generally found little or no benefit with soy, although research is ongoing to determine whether specific components of soy, such as genistein, help hot flashes.

  • Black cohosh. Black cohosh has been popular among many women with menopausal symptoms. Studies of black cohosh's effectiveness have had mixed results, and the supplement might be harmful to the liver in rare circumstances.
  • Ginseng. While ginseng may help with mood symptoms and insomnia, it doesn't appear to reduce hot flashes.
  • Dong quai. Study results indicate that dong quai isn't effective for hot flashes. The supplement can increase the effectiveness of blood-thinning medications, which can cause bleeding problems.
  • Vitamin E. Taking a vitamin E supplement might offer some relief from mild hot flashes. In high doses, it can increase your risk of bleeding.

Preparing for your appointment

For hot flashes, you'll likely start by seeing your family doctor or gynecologist.

What you can do

Before your appointment, make a list of:

  • Your symptoms, including how many hot flashes you have a day and how severe they are
  • Medications, herbs, vitamins and supplements you take, including doses
  • Questions to ask your doctor

Take a family member or friend with you, if possible, to help you remember the information you get. Bring along a notepad or device to jot down information you receive.

Some basic questions to ask your doctor include:

  • Do I need any tests?
  • What treatments are available to help with my symptoms?
  • What else can I do to relieve my symptoms?
  • Are there alternative therapies I can try?
  • Do you have printed information I can have? What websites do you recommend?

If other questions occur to you during the appointment, don't hesitate to ask them.

What to expect from your doctor

Some questions your doctor might ask include:

  • Are you still having periods?
  • When was your last period?
  • How often do your symptoms bother you?
  • How uncomfortable do your symptoms make you?
  • Does anything seem to help?
  • Does anything make your symptoms worse?